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Complex distal femoral fracture (DFF) in the elderly patient is an infrequent but challenging scenario. In these fragile patients, DFF is associated with a high rate of medical complications and mortality. The optimum treatment remains controversial. Our aim is to propose our standard treatment, describe our results and discuss its clinical relevance. We describe three cases of elderly and fragile patients with multiple comorbidities who suffered a complex DFF after low energy trauma. They were successfully treated through a primary arthroplasty with distal femoral replacement (DFR). All the three patients presented early full weight-bearing mobilization (average time to first ambulation was five days), good functional outcome (mean knee range of motion was 103°) and short hospital length of stay (mean of ten days). According to our experience, primary arthroplasty with DFR could be a good therapeutic option for complex DFF in elderly patients.

Background Recent MRI-based studies have raised great concern about frequent cardiac involvement even in mild or asymptomatic COVID-19. However, while signs of myocardial injury were found in large proportions of patients after COVID-19, all studies published to date lack baseline imaging and are therefore unable to discriminate between pre-existing and COVID-19-induced injury. Purpose In this longitudinal study, we aimed to assess the true cardiac impact of COVID-19 based on pre- and post-COVID-19 late gadolinium enhancement (LGE)-MRI. Methods A prospective registry of patients with serial LGE-MRIs was screened for patients with documented SARS-COV-2 infection after cardiac LGE-MRI. Eligible patients then received a post-COVID-19 LGE-MRI using the same scanner and sequence as in the pre-COVID-19 MRI. Inversion recovery prepared T1-weighted gradient echo sequences were acquired in sinus rhythm using ECG gating and a free-breathing 3D navigator, 15–20 minutes after administering an intravenous bolus of 0.2 mmol/kg of gadobutrol. A TI scout sequence was used in order to determine the optimal TI that nullified the left ventricular myocardial signal. The presence of LGE was independently assessed qualitatively by two experienced investigators blinded to patient information. For quantitative analyses a 3D-reconstruction of the left ventricle was performed using ADAS-3D software. LGE was then automatically quantified based on a prespecified signal intensity threshold of ≥3 SD above the mean of a remote non-enhanced myocardial region. Results Pre- and post-COVID LGE-MRI from 31 patients with cardiovascular risk factors that had recovered from mild to moderate COVID-19 (23% hospitalised) were analysed. At a median of 5 months post-COVID-19, LGE-lesions indicative of myocardial injury were encountered in 15 out of 31 patients (48%), which is in line with previous reports. However, intraindividual comparison with the pre-COVID-19 MRI reveiled all of these lesions as pre-existing and thus not COVID-19-related. Quantitative analysis detected no increase in the size of individual LGE-lesions, nor in the global left ventricular LGE-extent. There was no difference in any functional or structural parameter between pre- and post-COVID-19 MRI. Conclusion This longitudinal study in a cohort of patients considered at high risk of cardiac involvement, did not find any evidence for COVID-19-induced myocardial injury. The complete absence of de novo LGE lesions in this cohort is reassuring and indicates that cardiac sequelae of COVID-19 are rare and certainly not as common as previously suggested. Funding Acknowledgement Type of funding sources: None.

Background Reperfusion networks have permitted improvements in reperfusion delays in primary percutaneous coronary intervention (PPCI)-treated ST elevation myocardial infarction (STEMI). However, the impact on myocardial salvage (MS) of direct transfer to the catheterization laboratory (cath-lab) to minimize system delay remains unknown. Objective We sought to quantify the myocardial salvage index (MSI) acutely and to assess adverse remodeling at 6 months in PPCI-treated STEMI according to the mode of patient presentation. Methods Between 2005 and 2021 we included 493 patients in a single center registry of first PPCI-treated STEMI who were studied with Late gadolinium enhanced (LGE) cardiac magnetic resonance (CMR) in the acute phase. Among them, 414 (84.0%) underwent a second LGE-CMR at 6 months. Subjects were classified depending on the mode of presentation: those diagnosed out-of-hospital and directly transferred to the cath-lab by the Emergency Medical Services (EMS group, 29.82%); subjects with first medical contact in a PCI-capable hospital (PCI-H group, 41.75%); and patients presenting to a non-PCI-capable center and transferred for PCI (non-PCI-H group, 28.43%). We computed the angiographic area at risk by BARI score, and combined it with the LGE-CMR derived infarct size to compute a validated MSI, expressed as percentage of area at risk. The change in ejection fraction (EF) and indexed left ventricle end-diastolic volume (iLVEDV) from baseline to 6 months was also computed. Results The mean age was 58.9±11.9 years, 84.5% were male and 51.4% had anterior STEMI. Total median ischaemic time was (median (interquartile range)) 126 (105–161) min in the EMS group, 201 (145–321) min in the PCI-H group and 300 (173–592) min in the non-PCI-H group (p Conclusions Patients with out-of-hospital diagnostis of STEMI by the EMS who were directly transferred to the cath-lab showed shorter total ischaemic times, resulting in increased myocardial salvage and a trend towards improved indexes of left ventricular function at 6 months. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Grant from La Maratό de TV3 and grant from Fundaciό La Caixa

Background Electrical reconnection of pulmonary veins (PV) is considered an important determinant of recurrent atrial fibrillation (AF) after PV isolation (PVI). However, it requires an invasive repeat procedure to assess durability of PVI. Against this background, in most centers clinically relevant AF recurrences almost automatically trigger repeat ablation procedures aiming at PV re-isolation. However, technological and procedural advances have substantially improved efficacy of catheter ablation. As a result it is increasingly common that all four PVs are found isolated in those repeat procedures. Thus, as ablation of extra-PV targets has failed to show benefit in large randomized trials, more and more often these highly invasive procedures are being performed only to confirm durable PVI. To date, late gadolinium enhancement (LGE)-MRI is the only non-invasive method to assess ablation lesions. However, its predictive value regarding PVI durability has not been systematically determined. Purpose Here we aim to define the ability of LGE-MRI to rule out PV reconnection and its potential to guide patient selection for repeat ablation procedures. Methods This study was based on our prospective registry where all patients receive an LGE-MRI before and after AF ablation. All patients that had undergone a repeat invasive procedure after an initial PVI-only ablation were included, and the ability of LGE-MRI to determine PVI durability was analysed using invasive mapping as a reference. Gradient echo MR sequences were acquired in sinus rhythm and 3D-reconstruction of left atrium and PVs performed using ADAS-3D software. LGE was quantified based on the signal intensity ratio of each voxel relative to the blood pool, applying a previously validated threshold of >1.2 to define LGE indicative of ablation-induced scarring. LGE discontinuations of >3 mm were considered indicative of PV reconnection. For validation, PVI durability was determined invasively based on local bipolar electrograms. Results A total of 142 patients and 284 PV pairs were analysed. LGE-MRI displayed LGE-discontinuations suggestive of PV reconnection in 210 PV pairs (74%). According to invasive mapping, LGE-MRI predicted PV reconnection with high sensitivity (89%), whereas specificity was somewhat lower (48%). Of note, a complete circumferential LGE-lesion reliably ruled out electrical reconnection of the respective PV pair with a negative predictive value of 94.5%. In the patient-based analyses 11% of the patients displayed complete LGE-lesion sets encircling all 4 PVs. None of these patients showed electrical PV reconnection in the invasive repeat procedure. Conclusion Although not frequently encountered, continuous LGE lesions encircling all 4 PVs reliably rule out PV reconnection. Thus, LGE-MRI has the potential to guide treatment decisions in patients with AF recurrences and may help to avoid unnecessary repeat procedures with all their associated risks and costs. Funding Acknowledgement Type of funding sources: None.

Background Being born small-for-gestational age (SGA, 10 percent of all births) is associated with increased risk of cardiovascular mortality (1,2) in adulthood together with lower exercise tolerance (3), but mechanistic pathways are unclear. Central obesity is known to worsen cardiovascular outcomes, but it is uncertain how it affects the heart in adults born SGA. Purpose We aimed to assess whether central obesity makes young adults born SGA more susceptible to cardiac remodelling and dysfunction. Methods A perinatal cohort study including 80 young adults born SGA (birth weight below 10th centile) and 75 adults with normal birth weight (controls). Current waist-to-hip ratio was used as a surrogate of central obesity. Cardiac structure and function were assessed by cardiac magnetic resonance. Statistical shape analysis was used to study the regional geometric variability of the biventricular surfaces produced by central obesity and SGA, and synthetic surfaces representative of obese and non obese were generated for both SGA and controls. Results Figure 1 shows the superimposed representative surfaces of obese and non-obese according to our model, for controls (right column) and SGA (left column). Both SGA and waist-to-hip were highly associated to cardiac shape (F=3.94 p Conclusions SGA young adults show unique cardiac adaptation to central obesity, which is associated with a decrease in stroke volume. Preventive strategies aiming to reduce cardiometabolic risk in SGA population may be warranted. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union Horizon 2020 Programme

Individual differences in reading skill have frequently been related to variability in working memory capacity; however, it is unclear what drives this relation. The present study investigated two ...

An increasing body of research has investigated how bilingual language experience changes brain structure and function, including changes to task-free, or “resting-state” brain connectivity. Such findings provide important evidence about how the brain continues to be shaped by different language experiences throughout the lifespan. The neural effects of bilingual language experience can provide evidence about the additional processing demands placed on the linguistic and/or executive systems by dual-language use. While considerable research has used MRI to examine where these changes occur, such methods cannot reveal the temporal dynamics of functioning brain networks at rest. The current study used data from task-free EEGS to disentangle how the linguistic and cognitive demands of bilingual language use impact brain functioning. Data analyzed from 106 bilinguals and 91 monolinguals revealed that bilinguals had greater alpha power, and significantly greater and broader coherence in the alpha and beta frequency ranges than monolinguals. Follow-up analyses showed that higher alpha was related to language control: more second-language use, higher native-language proficiency, and earlier age of second-language acquisition. Bilateral beta power was related to native-language proficiency, whereas theta was related to native-language proficiency only in left-hemisphere electrodes. The results contribute to our understanding of how the linguistic and cognitive requirements of dual-language use shape intrinsic brain activity, and what the broader implications for information processing may be.

Previous research has demonstrated that individual differences in conflict management predict second-language (L2) reading skill. The current experiment tested the hypothesis that this relation reflects the need to manage conflict from cross-linguistic interactions (CLI). A novel model specifying the relation between L2 reading skill, CLI, and the predictors of such interactions was tested in 253 L2 English speaking adults, using structural equation modeling. In support of the hypothesis, the findings revealed that stronger CLI was related to poorer L2 reading skill. In addition, variability in non-linguistic conflict management, as measured by executive attention tasks, and relative language dominance reliably predicted CLI. Specifically, better conflict management and lower L1 dominance corresponded to fewer interactions. These results fill a crucial gap by demonstrating for the first time that the ability to manage CLI is critical to L2 reading, and that both cognitive skills and language experience contribute to variability in these interactions.

Background Interpreting patient phenotypes is a challenge when screening for hypertrophic cardiomyopathy (HCM). Machine learning (ML) can potentially help with advanced data integration - combining information contained in whole-cardiac cycle echo deformation and velocity profiles with standard clinical variables. The aim is to apply an ML approach to integrate whole cardiac cycle echo data with clinical variables to explore HCM phenotypes. Methods The cohort consisted of 138 participants from two centres: HCM patients (n=91) and relatives (n=47). Echocardiography was performed, whereas magnetic resonance and genetic testing in 48% and 82%, respectively. Whole cardiac cycle echo data (mitral and aortic velocity profiles, and six regional left ventricular (LV) deformation curves) were combined with clinical variables (age, sex, heart rate, e' medial and e' lateral) and used as the ML input. An unsupervised ML algorithm created a representative space where participants were positioned based on integrated data, blinded to disease status. Clustering was used to determine phenogroups and estimate the average characteristics. Data on family history (FHx), genotype, arrhythmias or syncope, implantable cardioverter-defibrillators (ICD), and late gadolinium enhancement (LGE) were used to interpret the phenogroups. As the LA diameter was not available in the dataset, the HCM risk for sudden cardiac death (SCD) was not calculated, however, the Table shows relevant variables to infer clinical risk. Results Clustering divided the participants into 6 phenogroups (P1–6) (Figure). Average echo profiles are shown in the Figure, while the clinical data in the Table. P1/2 was defined by symptomatic patients with a high prevalence of positive genotypes, a positive FHx of SCD, and a burden of comorbidities. Echo findings showed pronounced structural/functional remodeling, and P1 was associated with severe septal hypertrophy and outflow tract obstruction. The high prevalence of ICD devices defined P1/2 as high risk groups. In comparison, patients in P3/4 were younger, with milder LV hypertrophy, but still considerable functional impairment. P3 had a higher burden of FHX and a higher prevalence of pathogenic mutations, whereas P4 a higher incidence of hypertension, high heart rate, mitral inflow fusion and findings of LGE. Finally, P5/6 consisted of younger individuals, predominantly HCM relatives, with a mild phenotype and, thus, low inferred risk. As expected, the majority of patients with the genetic variants of undetermined significance were located in P5. Conclusion ML can help derive clinically interpretable phenotypes in HCM based on the automated integration of whole cardiac cycle deformation and velocity data with conventional clinical parameters. The derived phenogroups correspond with established risk profiles in HCM. An expanded dataset is needed to enable further exploration of the phenotype-genotype relations and to define prognostic value. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by the Horizon 2020 European Commission Project H2020-MSCA-ITN

Despite the importance of memories in everyday life and the progress made in understanding how they are encoded and retrieved, the neural processes by which declarative memories are maintained or forgotten remain elusive. Part of the problem is that it is empirically difficult to measure the rate at which memories fade and, without such a measure, it is hard to identify the corresponding neural correlates. This study addresses this problem using a combination of individual differences, model-based inferences, and resting-state functional connectivity. The individual-specific values of rate of forgetting in long-term memory (LTM) were estimated for 33 participants using a formal model fit to data from an adaptive fact learning task. Individual rates of forgetting were then used to examine participant-specific patterns of resting-state fMRI connectivity, using machine-learning techniques to identify the most predictive and generalizable features. Consistent with the existing literature, our results identified a sparse, distributed network of cortical and subcortical regions that underlies forgetting in LTM. Cross-validation showed that individual rates of forgetting were predicted with high accuracy (r = .96) from this connectivity pattern alone. These results open up new opportunities for the study of individual differences in LTM function and dysfunction.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Spanish Government, Madrid, Spain [FIS_PI16/00435 Background Late gadolinium enhancement MRI (LGE-MRI) is increasingly used to detect native as well as ablation-induced atrial fibrosis in the context of atrial fibrillation (AF). However, cardiac fibrotic tissue including ablation lesions is subject to sustained remodeling, and neither the development of ablation-induced fibrosis over time nor the capability of LGE-MRI to detect it at different stages of scar formation have been defined. We sought to define the long-term development of ablation-induced atrial fibrosis and to validate LGE-MRI for the assessment of ablation lesions at different time points. Methods Patients with first-time AF ablation and an early follow-up LGE-MRI (3 months post ablation) and a late follow-up LGE-MRI (>12 months post ablation) were included. LGE-MRI data were postprocessed for quantification of fibrotic tissue using the ADAS 3D software. In the majority of patients high-density electroanatomical mapping (EAM), performed in a repeat procedure served as a reference. Results 22 consecutive patients fulfilling the inclusion criteria were analysed retrospectively. In the LGE-MRI 3 months post ablation an average of 91.7 ± 7.0% of the ablation lines" circumference displayed late gadolinium enhancement (LGE) reflecting ablation-induced fibrosis, whereas in the late follow-up LGE-MRI, at a median of 28 months post ablation, only 62.8 ± 25.0% of the ablation lines" circumference was covered by LGE (p Conclusions Our results indicate that while ablation-induced atrial fibrosis appears to remain rather constant over time, LGE-MRI loses some of its capability to detect it. Thus, LGE-MRI 3 months post ablation may be more accurate in the detection of durable ablation lesions than LGE-MRI at later time points more than 12 months after ablation. Abstract Figure

The ability to reason and problem-solve in novel situations, as measured by the Raven's Advanced Progressive Matrices (RAPM), is highly predictive of both cognitive task performance and real-world outcomes. Here we provide evidence that RAPM performance depends on the ability to reallocate attention in response to self-generated feedback about progress. We propose that such an ability is underpinned by the basal ganglia nuclei, which are critically tied to both reward processing and cognitive control. This hypothesis was implemented in a neurocomputational model of the RAPM task, which was used to derive novel predictions at the behavioral and neural levels. These predictions were then verified in one neuroimaging and two behavioral experiments. Furthermore, an effective connectivity analysis of the neuroimaging data confirmed a role for the basal ganglia in modulating attention. Taken together, these results suggest that individual differences in a neural circuit related to reward processing underpin human fluid reasoning abilities.

Funding Acknowledgements Type of funding sources: None. Introduction Myocardial T1 mapping constitutes a reliable indicator of heart diseases related to changes of myocardial extracellular content (e.g. oedema, fibrosis) as well as fat, iron and amyloid content. T1-mapping techniques rely on fitting a model to a series of MRI measurements. Alignment between these measurements is required for accurate T1 estimation. This is limited by triggering accuracy and patient motion. Image registration is often applied to improve the alignment. In the case of MOLLI series, registration is compromised by contrast variation between the images. We present the validation of a new registration method, designed to account for the contrast properties of MOLLI data. Methods A cohort of 186 patients referred for a CMR was included in this study (115 M / 71 F; weight 75 ± 15 Kg; age 55 ± 16). Scans on a 3.0T MR included a MOLLI sequence with target parameters: 2D bSSFP, 160x148, pFOV 0.8-1.0, 1.4x1.4mm², ST 8mm, TE 1.4ms, TR 3.0ms, FA 35deg, NEX 1, BW 100kHz, 2x ASSET, 5(3)3. Cartesian 2D reconstruction followed by motion correction was applied retrospectively. A new correction algorithm was implemented, based on a similarity criterion that accounted for T1 relaxation: It consisted of an iterative approach alternating polarity estimation, T1 fitting, relaxation simulation and frame registration. The coefficient of determination (R²) was used as a quality measure. A representative subset of the results was reviewed by two experienced cardiologists. Results All reconstructions (totalling 1133 2D MOLLI series) yielded qualitatively correct T1 maps. Results with the new method were compared to conventional motion correction and no correction. The number of pixels with R²>0.95 was 85%±9% with standard motion correction and 90%±7% with the new dedicated method. In terms of improvement w.r.t. uncorrected data, the standard method yielded +3%±8% and the new one +9%±8%. Motion correction caused noticeable performance degradation in 12% of cases with the standard method, compared to 0.2% with the proposed method. The relative performance of the different methods can be appreciated in Figure 3. Discussion Despite T1 mapping techniques constituting a reliable diagnostic tool in cardiac imaging, they remain sensitive to patient motion and triggering inaccuracies, making them vulnerable to arrhythmia episodes. Improving the similarity criterion by accounting for T1 relaxation significantly decreased the incidence of misregistration and subsequent T1 inaccuracies. Using the R² of the voxel-wise T1 fit as a surrogate of alignment allowed to confirm the increased robustness of the new, dedicated motion correction method for MOLLI series. Conclusion We have demonstrated a new reconstruction pipeline with built-in registration, optimized for MOLLI T1-mapping. Using a large database of clinical data, the new method has been shown to improve the robustness to motion of cardiac T1 mapping. Abstract Figure.

Table S1: Details of marker placement used for the computation of inverse kinematics

Funding Acknowledgements Type of funding sources: None. Introduction Myocardial delayed enhancement (MDE) MRI plays an important role in the identification of several cardiac conditions, both ischemic and non-ischemic (e.g. myocarditis, IDC, amyloidosis). 3D imaging offers increased resolution, full heart coverage and better depiction of complex pathologies, but its image quality is limited by long acquisition times. Deep learning (DL) models enable advanced reconstruction algorithms that yield regularized images in practical computation times. In this study we evaluate a novel 3D-DL reconstruction to overcome the trade-off between reconstructed quality and acquisition time on MDE data. Methods A group of 14 subjects referred for CMR (5 F / 9 M, 59 ± 11 y.o., 78 ± 13 kg) were scanned with a 3D MDE sequence prototype: SPGR with IR preparation, fat & spatial saturation, respiratory navigator, ARC 2x, FOV 40x40cm, ST 1.4-2.4mm, matrix 280²-320², FA 20deg, BW 62.5 kHz, TE 2.1 ± 0.1ms, TI based on a CINE IR scout. All were retrospectively reconstructed using a 3D DL algorithm, trained on a database of over 700 datasets to reconstruct high-quality images with adjustable noise reduction. The images were compared with standard 3D Cartesian reconstruction by two experienced cardiologists, to identify alterations in morphology or contrast distribution. Noise was estimated using the intensity standard deviation on a blood pool ROI. Feature preservation was estimated using the structural similarity index (SSI). Results The new method improved perceived image quality without loss of structural information or resolution (fig 1). Quantitative analysis (fig 2) confirmed these results: The average coefficient of variation in the blood was 0.08 ± 0.02 in the reference and 0.05 ± 0.02 with the new method; Given a target image noise level, DL reconstruction yielded up to 10% better SSI, compared to anisotropic filtering. The clinical review didn’t reveal diagnostically significant alterations of structure or uptake pattern. A perceived reduction of sharpness was initially reported but individual examination of landmarks (e.g. pulmonary and coronary arteries) confirmed that no relevant features were being lost with the new reconstruction. Discussion The 3D MDE images obtained with DL reconstruction improved the trade-off between image noise -estimated by the blood pool intensity deviation- and feature preservation -estimated by SSI-. Consistent improvement of image quality without morphological alterations of diagnostic relevance indicates that the new method can be considered for clinical practice. The next step in the validation process will require testing the robustness over a large set of cases with heterogeneous acquisition settings. Conclusion We presented the preliminary evaluation of a deep learning reconstruction method with 3D myocardial delayed enhancement data. The results show systematic improvement of overall image quality without loss of relevant diagnostic information. Abstract Figure.

Table S1: Details of marker placement used for the computation of inverse kinematics; Table S2: Analysis of swing variation with the computation of magnitude (noted M, corresponding to the amplitude difference expressed in percentage) and phase (noted P, corresponding to the temporal shift expressed in percentage) between swings for kinematics and EMG, using the formulas of Sprague and Geers [62]. In order to assess the degree of repeatability, swing variation significance was tested using two (kinematic and electromyography) three-way (M/P*technique* muscle/angle) independent measure ANOVA. PH vs BP $; PH vs FH ¤

Figure S2: Results of statistical parametric mapping (SPM) tests between each technique for each joint-angle.

Figure S1: Separation of the strike cycles into 3 phases, based on the vertical displacement of a reflective marker fixed on the 5th metacarpal bone: up-swing (highlighted in blue), down-swing (yellow) and analysis phase (green). Custom Matlab routines were used to automatically and consistently identify the peaks and valleys.

Figure S3: Results of statistical parametric mapping (SPM) tests between each technique for each muscle activity.

Table S2: Analysis of swing variation with the computation of magnitude (noted M, corresponding to the amplitude difference expressed in percentage) and phase (noted P, corresponding to the temporal shift expressed in percentage) between swings for kinematics and EMG, using the formulas of Sprague and Geers [62]. In order to assess the degree of repeatability, swing variation significance was tested using two (kinematic and electromyography) three-way (M/P*technique* muscle/angle) independent measure ANOVA. PH vs BP $; PH vs FH

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 (764738) and the Clinical Research in Cardiology grant from the Spanish Cardiac Society. Background The aetiology of left ventricular hypertrophy (LVH) is a relevant clinical challenge with consequences for patient management. Phenotypes resulting from hypertensive remodelling and sarcomere mutation often overlap. Synchrotron X-ray phase-contrast imaging (X-PCI) is a technique that can provide 3-dimensional detailed information on myocardial micro-structure non-destructively. The aim is to relate macrostructural/functional, non-invasive, imaging phenotypes of hypertrophic cardiomyopathy (HCM) to the underlying myocardial microstructure assessed with X-PCI. Methods Myocardial tissue samples were obtained from three patients (P1-3) with obstructive myocardial hypertrophy undergoing septal myectomy. Medical history and the 5-year HCM risk scores were evaluated. The patients were imaged with magnetic resonance imaging and echocardiography prior to procedure. Myocardial structure was assessed with wall thickness, late gadolinium enhancement (LGE), whereas function with speckle-tracking deformation (STE) and tissue Doppler imaging (TDI). Myectomy tissue was imaged with X-PCI in the TOMCAT beamline, using a multiscale propagation-based protocol combining a low-resolution (LR) and a high-resolution (HR) setup (5.8 and 0.7 um pixel size, respectively). Results The clinical and imaging data are shown in Fig 1. On initial assessment, wall thickness, LGE distribution, global longitudinal strain and septal TDI demonstrated a similar macrostructural and functional phenotype of P1 and P2, whereas P3 stood out with more severe hypertrophy, scarring and dysfunction. Additional regional deformation analysis with STE revealed reduced deformation in the basal and mid septum in P1, paired with a hypertensive pattern of post-systolic shortening (PSS) (yellow arrows). In comparison, in P2 and P3, deformation was more heterogeneous regionally, with regions of almost complete absence of deformation (orange arrows). Upon further exploration with TDI, areas with abnormal deformation were identified on the transition from basal to mid septum in both P2 and P3, whereas deformation was normal, but reduced in P1, and paired with PSS. LR X-PCI defined regions of interest to scan with HR (yellow frame), where HR revealed extensive interstitial fibrosis (orange arrow) with normal myocyte size and organisation in P1, compatible with severe hypertensive remodelling. However, in P2 and P3, patches of fibrosis (yellow arrow) paired with enlarged myocytes organized in visible disarray, considerably more prominent in P3, were both compatible with sarcomere-mutation HCM. Conclusion The results demonstrate multiscale phenotyping of HCM - relating micro- and macrostructural findings to function, and integrating multimodality data. In-depth regional deformation analysis, validated by synchrotron-based microstructural analysis, showed potential to identify distinct imaging phenotypes in HCM, distinguishing between overlapping presentations in different aetiologies. Abstract Figure 1

Background Adverse Left Ventricular (LV) remodeling (ALVR) following ST-segment Elevation Myocardial Infarction (STEMI) is the result of numerous mechanical, neurohormonal, micro and macrovascular factors, and remains a major clinical problem. Cardiac Magnetic Resonance (CMR) is a multimodality technique that provides comprehensive functional and tissue characterization of infarcted and non-infarcted myocardium. Whether changes in the extracellular matrix in the remote myocardium in patients following a STEMI are associated with adverse LV remodeling has been a topic of debate. Aim We explored the additive value of native T1 variation (ΔnT1) and derived-extracellular volume (ECV) fraction in the remote non-infarcted myocardium as predictors of adverse LV remodeling following STEMI. Methods A total of 99 subjects (83% male) with their first mechanically reperfused STEMI underwent CMR within 2 weeks and at 6 months, including T1 mapping prior and 15 to 20 minutes following a bolus of gadolinium (0.2 mmol/kg), with a MOLLI sequence. ECV and nT1 values were computed by averaging co-registered ROIs in three distinct segments in the remote non-infarcted myocardium. Results Baseline nT1 but not ECV correlated with infarct size (r=0.349, P ALVR, defined as Δ>20% inLVEDVi, occurred in 21 cases, despite optimal medical therapy. Subjects with ALVR showed greater ΔnT1 (13.2±44.1 vs −5.2±30.2 ms, P Conclusions The nT1 variation in remote non-infarcted myocardium and the extent of microvascular obstruction are superior to ECV changes and infarct size in predicting ALVR following STEMI. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fundaciό La Maratό TV3 2015 30 31 32. Fondos FEDER

Increasingly, neuroimaging researchers are exploring the use of real-time functional magnetic resonance imaging (rt-fMRI) as a way to access a participant’s ongoing brain function throughout a scan. This approach presents novel and exciting experimental applications ranging from monitoring data quality in real time, to delivering neurofeedback from a region of interest, to dynamically controlling experimental flow, or interfacing with remote devices. Yet, for those interested in adopting this method, the existing software options are few and limited in application. This presents a barrier for new users, as well as hinders existing users from refining techniques and methods. Here we introduce a free, open-source rt-fMRI package, the Pyneal toolkit, designed to address this limitation. The Pyneal toolkit is python-based software that offers a flexible and user friendly framework for rt-fMRI, is compatible with all three major scanner manufacturers (GE, Siemens, Phillips), and, critically, allows fully customized analysis pipelines. In this article, we provide a detailed overview of the architecture, describe how to set up and run the Pyneal toolkit during an experimental session, offer tutorials with scan data that demonstrate how data flows through the Pyneal toolkit with example analyses, and highlight the advantages that the Pyneal toolkit offers to the neuroimaging community.

Funding Acknowledgements none Background Electroanatomical map (EAM) detects areas of low voltage as a surrogated marker of fibrosis areas, being the reference technique for its detection. Cardiac magnetic resonance with Late Gadolinium enhancement (CMR-LGE) allows non-invasive detection of atrial fibrotic areas. CMR-LGE studies have focused on the left atrium since now. Purpose We need to validate this test to extend its use to the right atrium (RA), since it is involved in the arrhythmogenic substrate of several arrhythmias, and probably also in atrial fibrillation (AF). Methods Prospective observational study. Fifteen patients undergoing a first AF ablation procedure were included. All patients had a pre-procedural LGE-CMR performed. The blood pool-normalized intensity signal (image intensity ratio-IIR) was calculated for the right atrial wall, and values projected in a shell. IIR values validated for the left atrium were used to identify dense and intermediate fibrosis, and healthy tissue (>1.32, 1.2-1.32, Results A total of 8,830 points were obtained, mean per patient 588 (± 509) points. A global weak negative correlation was found between the EA bipolar voltage map (EAM) and IIR (CMR) (r= -0.16, p Conclusion There was an inverse correlation between the bipolar voltage EAM and IIR (CMR) of low grade but with statistical significance. CMR underestimated fibrotic tissue in RA with respect to its identification by EAM. Abstract Figure. Correlation between bipolar voltage-IIR

Background/Introduction Substrate-guided techniques have changed the approach and results of ventricular tachycardia (VT) ablation and electroanatomical voltage mapping (EAVM) constitutes a diagnostic and therapeutic cornerstone in this field. In current practice normal myocardium is typically characterized by bipolar voltage > 1.5 mV, dense scar Purpose The purpose of this study is to adjust voltage cut off in order to establish the threshold that more accurately define the pathological substrate in VT ablation. Additionally, predictors of usefulness of current thresholds are analyzed. Methods EAVM were created with CARTO3 System and Sensor-Force catheter (Navistar Smart-Touch and Pentaray). We delineated the conducting channels by analyzing the late potentials activation. Based on these channels we looked for the best cut-off values to detect these channels. We describe the baseline characteristics, the best cut-off values for border zone and scar core in our series and we analyzed the accuracy of the current established values to detect the arrhythmogenic VT substrate Results We investigated 51 patients (74,5% males; 41,2% ischemic cardiomyopathy, mean LVEF 38,6% +/-13,6) with sustained monomorphic VT submitted to ablation during 2016 and 2017. The range of the voltage adjustment was from 0,01-1 mV for core area and 0,2-6mV as maximum, with an average of 0,31-1,42mV. Using currently accepted bipolar voltage cut-off Conclusions EAVM is very important to detect scar and channels in VT ablation, but several elements can affect it and recently the traditional voltage values have been questioned. Our study suggests how the threshold as currently applied in daily practice could be acceptable to detect the core scar area, but it has to be reconsidered in NICM, especially regarding the border zone. An evident trend (p = 0,07) suggests a better accuracy of current values to define VT substrate in ischemic patients than in NICM. Abstract Figure. Channel Identification

Funding Acknowledgements No funding acknowledgements OnBehalf VT and sudden cardiac death Background The scar and the amount of border zone measured by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) has been proposed as an independent predictor of ventricular arrhythmias in patients with ischemic and non-ischemic cardiomyopathy. However, at the present time, the guidelines are based only on the ejection fraction to recommend an implantable cardioverter defibrillator (ICD) in primary prevention, and only a minority of these patients receive appropriate therapies. So, prevention needs to be improved. Purpose To identify predictors of appropriate therapies in patients with a primary prevention ICD using cardiac magnetic resonance imaging and a dedicated software (ADAS-3D) to characterize the scar. Methods All consecutive patients who underwent a LGE-MR prior to ICD implantation in primary prevention were prospectively included. Clinical and cardiac imaging characteristics were collected. The myocardium was segmented with ADAS-3D software in 10 layers (from endocardium to epicardium). The scar, border zone, core and conducting channels were automatically measured in grams by the software. Results Since 2008 to 2017, 206 patients were included. Mean age was 67 +/- 28 years, 80% men, mean ejection fraction 26%+/-9, 52% with ischemic cardiomyopathy and 48% non-ischemic. The primary endpoint was appropriate therapies and/or sudden cardiac death (SCD). Median follow-up was 46,33 months. 46 patients (22%) reached the primary endpoint. Greater scar mass (36,05 grams vs 21,5 grams; HR 1.04; 95% CI (1.03-1-05), p 5.3 grams was independently associated with the primary endpoint (HR: 4.77; 95% CI (1.15-19.73), p = 0.03). Conclusions The amount of border zone, core and channel mass measured by LGE-MR and ADAS software are independent predictors of appropriate therapies and SCD in patients with ICD in primary prevention. Abstract Figure. Scar characterization

This experiment employed an individual differences approach to test the hypothesis that learning modern programming languages resembles second “natural” language learning in adulthood. Behavioral and neural (resting-state EEG) indices of language aptitude were used along with numeracy and fluid cognitive measures (e.g., fluid reasoning, working memory, inhibitory control) as predictors. Rate of learning, programming accuracy, and post-test declarative knowledge were used as outcome measures in 36 individuals who participated in ten 45-minute Python training sessions. The resulting models explained 50–72% of the variance in learning outcomes, with language aptitude measures explaining significant variance in each outcome even when the other factors competed for variance. Across outcome variables, fluid reasoning and working-memory capacity explained 34% of the variance, followed by language aptitude (17%), resting-state EEG power in beta and low-gamma bands (10%), and numeracy (2%). These results provide a novel framework for understanding programming aptitude, suggesting that the importance of numeracy may be overestimated in modern programming education environments.

INTRODUCTION Isolated pulmonary endocarditis is a rare entity, especially in patients without predisposing factors, being its current incidence less than 1% of the total cases of infectious endocarditis. This is due to the lower right heart pressures and a decrease of intravenous drug-consum, being most of the cases nowadays, related to congenital right-heart diseases or pacemakers and defibrillators implants. CLINICAL CASE A 35 year-old man, tobacco smoker and intravenous cocaine consumer since he was 25, was admitted to our Emergency Department for fever up to 40ºC, cough and dyspnea started three days before admission. In the anamnesis he refereed intravenous consum of cocaine and sharing of syringes the last week. On physical examination he was tachycardic and signs of heart right failure were present such as jugular ingurgitation and peripheral edema. No murmurs were heard. No respiratory failure was detected at any time. Blood test analysis showed high levels of protein C reactive and leukocytosis. Blood cultures were positive for S. aureus (OXA-S) in the first 24h. Chest X-ray (image 1) showed a necrotizing bilateral pneumonia that was confirmed with the presence of cavitated images in the pulmonary CT (image 2). Antibiotic treatment was started with daptomicine + cloxaciline. With the suspicion of right endocarditis a transthoracic echocardiography was performed, showing the presence of a big vegetation (4x1cm) on the pulmonary valve that caused moderate pulmonary insufficiency (images 3, 4). Neither tricuspid nor left side valves were involved. Biventricular function was conserved and hyperdynamic. Endocarditis diagnosis was definitive and due to the presence of multiple right embolisms and the big size of the vegetation, the patient underwent cardiac surgery. Intra-surgical finding demonstrated a big vegetation of almost 5 cm (image 5) depending of the posterior pulmonary valve that was removed; the posterior valve needed to be repaired. Posterior clinical evolution was correct without complications, completing 17 days of i.v. antibiotics (cloxaciline) before discharge. CONCLUSIONS Right endocarditis is a rapidly progressive disease due to the fact that staphylococcus are the most frequent microorganisms involved. Valvular destruction and secondary embolic phenomena are the rule. Tricuspid valve is involved most of the times being the isolated pulmonary valve affection very uncommon. Abstract 474 Figure. CT, Echo and surgical images

Research on the neural bases of bilingual language control has largely overlooked the role of preparatory processes, which are central to cognitive control. Additionally, little is known about how the processes involved in global language selection may differ from those involved in the selection of words and morpho-syntactic rules for manipulating them. These processes were examined separately in an fMRI experiment, with an emphasis on understanding how and when general cognitive control regions become activated. Results of region-of-interest analyses on 23 early Spanish-English bilinguals showed that the anterior cingulate cortex (ACC) was primarily engaged during the language preparation phase of the task, whereas the left prefrontal (DLPFC) and pre-supplementary motor areas showed increasing activation from preparation to execution. Activation in the basal ganglia (BG), left middle temporal lobe, and right precentral cortical regions did not significantly differ throughout the task. These results suggest that three core cognitive control regions, the ACC, DLPFC, and BG, which have been previously implicated in bilingual language control, engage in distinct neurocognitive processes. Specifically, the results are consistent with the view that the BG “keep track” of the target language in use throughout various levels of language selection, that the ACC is particularly important for top-down target language preparation, and that the left prefrontal cortex is increasingly involved in selection processes from preparation through task execution.

This article describes the data analyzed in the paper “Individual differences in the Simon effect are underpinned by differences in the competitive dynamics in the basal ganglia: An experimental verification and a computational model” (Stocco et al., 2017) [1] . The data includes behavioral results from participants performing three cognitive tasks (Probabilistic Stimulus Selection (Frank et al., 2004) [2] , Simon task (Craft and Simon, 1970) [3] , and Automated Operation Span (Unsworth et al., 2005) [4] ), as well as simulationed traces generated by a computational neurocognitive model that accounts for individual variations in human performance across the tasks. The experimental data encompasses individual data files (in both preprocessed and native output format) as well as group-level summary files. The simulation data includes the entire model code, the results of a full-grid search of the model's parameter space, and the code used to partition the model space and parallelize the simulations. Finally, the repository includes the R scripts used to carry out the statistical analyses reported in the original paper.

While bilinguals differ from monolinguals in brain structure and function, the extent to which these differences impact non-linguistic cognitive abilities remains debated. The current set of experi...

La violence sexuelle est une preoccupation internationale qui passe notamment par la comprehension du fonctionnement des auteurs a l’initiative de ces comportements (AVS). Les theories nous proposent depuis toujours une lecture des fonctionnements psychiques des auteurs au travers de classifications rendant compte de la diversite des AVS. La pedophilie est definie dans le DSM 5 « par la presence de fantasmes et/ou de pulsions et/ou de comportements envers un enfant ou plusieurs enfants prepuberes » (APA, 2018). Cependant cette definition ne rend pas compte d’une certaine realite clinique que sont les auteurs ayant une preference ou une fixation pour des victimes, puberes mais non majeures. L’hebephilie (qui renvoie a l’attirance ressentie pour des enfants âges de 12 a 14 ans) est une categorie clinique qui, malgre les debats importants qu’ont suscite sa naissance, n’existe toujours pas dans les classifications modernes. Ce poster aura pour objectif d’exposer le debat historique autour de ce concept d’hebephilie a l’aide d’une situation clinique, d’en comprendre la definition grâce a une revue de la litterature scientifique sur le sujet pour enfin apprecier la necessite de l’existence ethique et clinique de cette entite psychopathologique.

Background and aim Post-procedure conduction abnormalities (CA) and paravalvular aortic regurgitation (PAR) continue to strain TAVI outcomes. Computer simulations, based on patient-specific anatomy, valve properties, and implantation position, have been validated for prediction of these complications. The new-generation CoreValve Evolut PRO has been shown to have lower levels of PAR and CA than previous generations. The aim was to compare clinical outcomes after Evolut Pro implantation in real-life with outcomes of virtual deployment of the same size, implantation depth adjusted CoreValve Evolut R. Methods Patients undergoing Evolut Pro implantation at a single centre were included into the study. Postoperative Doppler echocardiography was assessed to define PAR, the pre- and postoperative 12-lead ECGs for CA, and the postoperative angiograms to measure implantation depth based on annular plane distance from the non-coronary and left coronary aortic valve cusps. Preoperative multislice computed tomography was used to generate patient-specific models of the native aortic root. Implantation of the Evolut R valve and corresponding aortic root deformation was simulated using computational mechanics, whereas blood flow and level of PAR were predicted using computational fluid dynamics. Prediction of CA – new onset left bundle branch block or atrioventricular block type II or III -was based on calculations of contact pressure in a patient-specific region of the aortic root containing the AV conduction system (ROI). Outcomes were predicted in three implantation depth positions - high, medium, low – where the position closest to the real-life implantation depth was chosen for outcome comparisons. Results Study diagram is shown in Figure 1. Thirty-three patients (57% female, mean age 82±6 years old) underwent a TAVI intervention with an Evolut PRO valve. Evolut PRO implantation depths were, in general, closest to the lowest modeled Evolut R depth. Comparison demonstrated similar overall incidence of moderate-to-severe PAR. The Evolut R simulation predicted 18 patients without PAR and 2 with PAR. With the Evolute PRO, 1 of the 18 not predicted developed significant PAR, and 1 of the 2 predicted did not develop PAR. CA were notably higher with the Evolut R simulation, where CA were present in 9 out of 12 patients, as compared to the observed 5 out of 12 with the Evolut PRO. Figure 1 Conclusion Single-centre outcomes after Evolut Pro implantation in real-life showed a similar overall incidence of moderate-to-severe PAR and a lower incidence of conduction abnormalities as compared to the same size, implantation depth adjusted, patient-specific Evolut R modeled outcomes. As inferred from the results, computer simulations may have high clinical utility in supporting clinical decisions regarding valve choice in TAVI procedures. Acknowledgement/Funding Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 (764738)

The current study aimed to elucidate the contributions of the subcortical basal ganglia to human language by adopting the view that these structures engage in a basic neurocomputation that may account for its involvement across a wide range of linguistic phenomena. Specifically, we tested the hypothesis that basal ganglia reinforcement learning (RL) mechanisms may account for variability in semantic selection processes necessary for ambiguity resolution. To test this, we used a biased homograph lexical ambiguity priming task that allowed us to measure automatic processes for resolving ambiguity toward high-frequency word meanings. Individual differences in task performance were then related to indices of basal ganglia RL, which were used to group subjects into three learning styles: (a) Choosers who learn by seeking high reward probability stimuli; (b) Avoiders, who learn by avoiding low reward probability stimuli; and (c) Balanced participants, whose learning reflects equal contributions of choose and avoid processes. The results suggest that balanced individuals had significantly lower access to subordinate, or low-frequency, homograph word meanings. Choosers and Avoiders, on the other hand, had higher access to the subordinate word meaning even after a long delay between prime and target. Experimental findings were then tested using an ACT-R computational model of RL that learns from both positive and negative feedback. Results from the computational model simulations confirm and extend the pattern of behavioral findings, providing an RL account of individual differences in lexical ambiguity resolution.

We present BrainNet which, to our knowledge, is the first multi-person non-invasive direct brain-to-brain interface for collaborative problem solving. The interface combines electroencephalography (EEG) to record brain signals and transcranial magnetic stimulation (TMS) to deliver information noninvasively to the brain. The interface allows three human subjects to collaborate and solve a task using direct brain-to-brain communication. Two of the three subjects are designated as “Senders” whose brain signals are decoded using real-time EEG data analysis. The decoding process extracts each Sender’s decision about whether to rotate a block in a Tetris-like game before it is dropped to fill a line. The Senders’ decisions are transmitted via the Internet to the brain of a third subject, the “Receiver,” who cannot see the game screen. The Senders’ decisions are delivered to the Receiver’s brain via magnetic stimulation of the occipital cortex. The Receiver integrates the information received from the two Senders and uses an EEG interface to make a decision about either turning the block or keeping it in the same orientation. A second round of the game provides an additional chance for the Senders to evaluate the Receiver’s decision and send feedback to the Receiver’s brain, and for the Receiver to rectify a possible incorrect decision made in the first round. We evaluated the performance of BrainNet in terms of (1) Group-level performance during the game, (2) True/False positive rates of subjects’ decisions, and (3) Mutual information between subjects. Five groups, each with three human subjects, successfully used BrainNet to perform the collaborative task, with an average accuracy of 81.25%. Furthermore, by varying the information reliability of the Senders by artificially injecting noise into one Sender’s signal, we investigated how the Receiver learns to integrate noisy signals in order to make a correct decision. We found that like conventional social networks, BrainNet allows Receivers to learn to trust the Sender who is more reliable, in this case, based solely on the information transmitted directly to their brains. Our results point the way to future brain-to-brain interfaces that enable cooperative problem solving by humans using a “social network” of connected brains.

Bilingual language control is characterized by the ability to select from amongst competing representations based on the current language in use. According to the Conditional Routing Model (CRM), this feat is underpinned by basal-ganglia signal-routing mechanisms, and may have implications for cognitive flexibility. The current experiment used dynamic causal modeling of fMRI data to compare network-level brain functioning in monolinguals and bilinguals during a task that required productive (semantic decision) and receptive (language) switches. Consistent with the CRM, results showed that: (1) both switch types drove activation in the basal ganglia, (2) bilinguals and monolinguals differed in the strength of influence of dorsolateral prefrontal cortex (DLPFC) on basal ganglia, and (3) differences in bilingual language experience were marginally related to the strength of influence of the switching drives onto basal ganglia. Additionally, a task-by-group interaction was found, suggesting that when bilinguals engaged in language-switching, their task-switching costs were reduced.

Research on the biological basis of autism spectrum disorder has yielded a list of brain abnormalities that are arguably as diverse as the set of behavioral symptoms that characterize the disorder. Among these are patterns of abnormal cortical connectivity and abnormal basal ganglia development. In attempts to integrate the existing literature, the current paper tests the hypothesis that impairments in the basal ganglia's function to flexibly select and route task-relevant neural signals to the prefrontal cortex underpins patterns of abnormal synchronization between the prefrontal cortex and other cortical processing centers observed in individuals with autism spectrum disorder (ASD). We tested this hypothesis using a Dynamic Causal Modeling analysis of neuroimaging data collected from 16 individuals with ASD (mean age = 25.3 years; 6 female) and 17 age- and IQ-matched neurotypical controls (mean age = 25.6, 6 female), who performed a Go/No-Go test of executive functioning. Consistent with the hypothesis tested, a random-effects Bayesian model selection procedure determined that a model of network connectivity in which basal ganglia activation modulated connectivity between the prefrontal cortex and other key cortical processing centers best fit the data of both neurotypicals and individuals with ASD. Follow-up analyses suggested that the largest group differences were observed for modulation of connectivity between prefrontal cortex and the sensory input region in the occipital lobe [t(31) = 2.03, p = 0.025]. Specifically, basal ganglia activation was associated with a small decrease in synchronization between the occipital region and prefrontal cortical regions in controls; however, in individuals with ASD, basal ganglia activation resulted in increased synchronization between the occipital region and the prefrontal cortex. We propose that this increased synchronization may reflect a failure in basal ganglia signal gating mechanisms, resulting in a non-selective copying of signals to prefrontal cortex. Such a failure to prioritize and filter signals to the prefrontal cortex could result in the pervasive impairments in cognitive flexibility and executive functioning that characterize autism spectrum disorder, and may offer a mechanistic explanation of some of the observed abnormalities in patterns of cortical synchronization in ASD.

Resumen El desarrollo de fibrosis miocardica es un proceso comun en la aparicion de disfuncion ventricular en muchas enfermedades cardiacas. La resonancia magnetica permite valorar la anatomia y la funcion cardiaca con precision, y su papel en la caracterizacion macroscopica de la fibrosis miocardica mediante las tecnicas de realce tardio ha sido ampliamente validado en clinica. En fechas recientes se ha demostrado que las tecnicas de mapeo T1 miocardico permiten la cuantificacion en terminos absolutos de la fibrosis difusa y de la expansion del espacio extracelular miocardico. Sin embargo, se necesitan estudios adicionales que consigan validar la utilidad de esta tecnica en la deteccion temprana del remodelado tisular en un momento en que la instauracion de un tratamiento precoz permita mejorar el pronostico de los pacientes. Este articulo revisa el estado actual de las tecnicas de mapeo T1 del miocardio, sus aplicaciones clinicas y sus limitaciones.

The development of myocardial fibrosis is a common process in the appearance of ventricular dysfunction in many heart diseases. Magnetic resonance imaging makes it possible to accurately evaluate the structure and function of the heart, and its role in the macroscopic characterization of myocardial fibrosis by late enhancement techniques has been widely validated clinically. Recent studies have demonstrated that T1-mapping techniques can quantify diffuse myocardial fibrosis and the expansion of the myocardial extracellular space in absolute terms. However, further studies are necessary to validate the usefulness of this technique in the early detection of tissue remodeling at a time when implementing early treatment would improve a patient's prognosis. This article reviews the state of the art for T1 mapping of the myocardium, its clinical applications, and its limitations.

Purpose: No consensus exists for the diagnosis of heart failure with preserved ejection fraction (HFPEF). Current studies recommend stress echocardiography protocols, but single standard peak or timing measurements are limited towards the complexity of the disease. We show the contribution of a combined analysis of multiple myocardial velocity patterns and investigate their relative relevance for the characterization of HFPEF. Methods: Velocity traces from 55 subjects were examined (69±6 years, 22 healthy, 19 HFPEF and 14 breathless subjects). Data came from tissue Doppler acquisitions at rest and exercise at the basal septum and lateral wall, and were temporally aligned to a common reference for comparison. Each phase of the cycle at each stage of the protocol was identified for analysis (figure). Unsupervised machine learning (multiple kernel learning) was used to characterize this population and automatically determine the relevance of each velocity pattern. Results: The learning found a discrimination algorithm that performed well in agreement with diagnosis based on current guidelines (sens=78.9%, spec=86.3%, K=0.65). The importance given to early diastole at exercise was substantially higher, while the isovolumic contraction was the lowest contributor. The breathless subjects were associated to their closest subgroup. Conclusion: The characterization of HFPEF is improved by a combined analysis of multiple velocity traces from stress echo studies using machine learning. The method additionally suggests features of interest to be used in clinical diagnosis.

Cardiac magnetic resonance imaging is considered the reference technique for characterizing myocardial tissue; for example, T2-weighted sequences make it possible to evaluate areas of edema or myocardial inflammation. However, traditional sequences have many limitations and provide only qualitative information. Moreover, traditional sequences depend on the reference to remote myocardium or skeletal muscle, which limits their ability to detect and quantify diffuse myocardial damage. Recently developed magnetic resonance myocardial mapping techniques enable quantitative assessment of parameters indicative of edema. These techniques have proven better than traditional sequences both in acute cardiomyopathy and in acute ischemic heart disease. This article synthesizes current developments in T2 mapping as well as their clinical applications and limitations.

Cardiac magnetic resonance imaging is considered the reference technique for characterizing myocardial tissue; for example, T2-weighted sequences make it possible to evaluate areas of edema or myocardial inflammation. However, traditional sequences have many limitations and provide only qualitative information. Moreover, traditional sequences depend on the reference to remote myocardium or skeletal muscle, which limits their ability to detect and quantify diffuse myocardial damage. Recently developed magnetic resonance myocardial mapping techniques enable quantitative assessment of parameters indicative of edema. These techniques have proven better than traditional sequences both in acute cardiomyopathy and in acute ischemic heart disease. This article synthesizes current developments in T2 mapping as well as their clinical applications and limitations.